NHS weight loss ‘help’ is a scandal

[Metabolicallycomplicated]

I have insulin resistant PCOS but I’m not diabetic, I just want to share my experience of asking for weight loss help.

I have (obviously) tried every diet, way of eating etc etc going, so in desperation I went to my GP and asked for some help to lose weight. I was referred to a weight loss service provided by an external supplier and was reassured they cater for people with diabetes and metabolic health issues like PCOS etc.

Anyway, I attended a few meetings and alarm bells started to ring when I was presented with a work book and turned to the ‘what to eat’ page to find the NHS healthy plate which is a diet made up of 30-40% carbohydrate, very little fat and moderate protein.

In the next meeting, I asked the dietician how this advice worked for people who were metabolically buggered and a guy with T2 diabetes also chirped up and asked the same. The response was ‘well we suggest eating low GI foods for carbs’…. So I asked ‘low Glycemic index or low glycemic load? Because those 2 things are different and for people with insulin resistant conditions, it’s a very important distinction?’. She didn’t answer the question and then proceeded to say the advice on the course was for the general population and she’d put me in touch with her supervisor for these specific questions and I could talk to her.

Losing faith at this point, I emailed the supervisor as instructed and along with specific diet questions I also asked for the statistics on how many people reach A 10% weight loss during the 12 week course, and how many people go on to maintain that weight loss for 2 and 5 years. That I would have thought, is a very simple question. The email I got back was ‘we don’t keep those statistics and why are you asking please?’… eh?? This is a course being prescribed by the NHS and you don’t actually have any statistics or proof points that it’s effective??

So I emailed back, thanked her for her response and withdrew myself from the course.

Why on earth are the NHS paying external companies to provide a treatment with no proven track record in successfully delivering adequate care?? It’s WILD. The way I see it, if you approached your GP for help with an infection and they said ‘here! Try this tablet. It’s never been clinically reviewed or tested, it’s not really designed for people with your specific problem and we have absolutely no clinical evidence that it works but we’re paying this company a fortune to supply it to you’ it would be a national scandal.

We have an obesity epidemic costing the NHS billions and yet absolutely no proper treatment available beyond dietary advice that has seen an explosion in weight related health issues over the last 50 years, which incidentally is based on junky science in the first place and fails to achieve and sustain weight loss in 97% of cases. NHS healthy plate is basically the food pyramid, which in turn is based on research that’s been totally and thoroughly debunked for over 2 decades now. Even ‘body reducing’ advice from the early 50’s focused on reducing carbohydrate, why on earth are we still pretending high carb low fat diets are the answer for a population that is rife with insulin resistant conditions?

The other fun bit is I’d have access to much more tailored advice is I was diabetic. I’m not, and instead because I’m female and my insulin resistance has resulted in PCOS and not diabetes, there is no specific dietary advice available for me despite a low carb diet being the single most impactful way to treat PCOS long term (it’s standard practice across much of the rest of the world now).

We’re here because we treat obesity like a moral failing and actually have no interest in helping fat people, just in berating them and treating them like they’re idiots with no self control. It should be a national scandal and at the very least, we should be calling out external suppliers who have somehow managed to secure massive NHS contracts with zero proof their treatment plan is in any way successful for the patient.

Honestly I don't find dieticians great anyway. I've a toddler who is likely autistic , has cmpa and severe food restrictions ( I suspect something along the lines of afrid) all I was told was to keep exposing him to foods and if he doesn't willingly put it in his mouth then I should help him. In other words I should force feed my 2 year old bits of food.

I agree with you. I did a NHS funded course on Zoom for people who are pre-diabetic and it was very poor, simplistic stuff based on calories and low fat diet. Several participants dropped out along the way. The calibre and knowledge of the trainers, with one exception, was poor and the slide shows were also simplistic. One thing I recall from the final session was being asked to guess the calorie content of various meal photos, one being a pizza. I guessed a high figure. The answer was 600 calories. I have no idea where the trainer got that one from, probably a resturant selling a thin 6 inch pizza with no cheese on it. The trainer did not qualify that figure in any way so the remaining participants are likely to have gone away with the idea that a whole pizza is only 600 calories. We were asked our weight every week and I don't think anyone was steadily losing which was no surprise.

I asked my gp for help and she said if I put on another stone she could refer me for a gastric band.

You're absolutely right in all the points you make about wasting money on an unproven course that fails to make any allowance for metabolic factors, which is the one group of people the NHS definitely should be helping.

However, the vast, vast majority of obesity in the UK (and worldwide) is due to crap food, too much of it, and insufficient exercise. I don't see how it's the NHS job (or failure) to put right decades of unsurmountable policy decisions that have led to this situation. Cutting PE and cookery in schools, allowing processed and high sugar foods to be sold cheaper than fresh, planning policy that has allowed a McDonald's on every other street corner, and near to schools - being overweight is almost predestined because of the society we live in.

.. The NHS is never going to overcome or put any of that right without the causative factors being properly addressed, and accepting that it is going to take decades.

But you probably did overeat to become overweight so just eat less/next to nothing for a few months and I’m sure you’d see some loss? Fat people treat being skinny as impossible but the reality is most of us just don’t eat that much.

Agree with you entirely. I am a researcher too and there's pretty much no mainstream advice that follows the recent science (or even 20 year old science!).

My latest fun self experiment is a continuous glucose monitor plus feeding my family the same and using a standard glucose monitor on them. Foods have such dramatically different effects on each of us and I've found several 'healthy' things that I just can't eat without huge prolonged spikes in my blood sugar with accompanying inflammation and inevitable drop and cravings for more.

If you haven't tried that it's so interesting. The ZOE app is even more thorough, checks your biome through a poo sample and gives you some specific composition muffins to eat to get early insight into how your body handles nutrients. Great if you can afford it but worth reading around it even if you can't.

You can but it needs to be precooked and then cooled and reheated and portion, this turns the carbohydrate into resistant carbs. A meal of reheated brown basmati and veg curry actually dropped my bs.

A diabetic can eat up too 100g of unrefined carbs in a day.

We’re here because we treat obesity like a moral failing and actually have no interest in helping fat people, just in berating them and treating them like they’re idiots with no self control.
this is absolutely correct.

It should be a national scandal and at the very least, we should be calling out external suppliers who have somehow managed to secure massive NHS contracts with zero proof their treatment plan is in any way successful for the patient.
absolutely. Is it a way to show the nhs is providing the care and can blame people for failing? Or, like PPE, is this a very easy way for someone to make money.

I'm sure she's thought of that.

Overeating is an addiction, we don't tell other addicts to just stop doing it.

And once you're overweight you've often screwed up your biome, your insulin response and your neural responses to food. It takes knowledge and incredible willpower to restore these, I think very difficult to do without support.

I was once referred to an NHS dietician for assistance with weight loss. I've always had a poor relationship with food since childhood. She told me I needed to avoid foods like cakes, biscuits etc. I told her I am aware of that. She then looked extremely puzzled and asked why I didn't do it then? I asked her if she'd had any training in understanding psychology of over eating etc and she just repeated I needed to stop eating cake. Obviously I never went back.

Health promotion, which includes weight loss services and diabetes education, isn't an NHS service. It's a service commissioned by Local Authorities (the council). So the responsibility for this course sits with them, not the NHS.

As for providing data, if the OP wants it, then it will be available via an FOI request, probably to the LA. The data will be there, the commissioners (the LA) will be given regular reports on a multitude of KPIs.

This too. I was sent to a dietitian early during both my pregnancies because my bmi was low. I went once and thought her ridiculous.

I would have expected them to know how many participants reached a 10% loss during the 12 week course though at least? They weigh participants weekly and record it so that should be data they own.

I am a bit confused about the 10%.

In studies that tried to assess the effects of wegovy over a 68 weeks period participants lost about 15% of their body weight on average.

That is considered quite successful in the world of non-surgical weight loss.

A weight loss of 10% on average via a course - especially sustained weigth loss of 10% - would therefore seem rather incredible to me.

Education about nutrition is incredibly important. I simply wish that it was offered and easily accessible to everyone. Prevention instead of treatment etc...

I had requested help with weight loss from my GP surgery many times, I insisted as I knew that courses were available, nothing happened. Then there was a post on Face book, with a questionnaire to fill in, to see if you would be eligible for a pre diabetes course, I am not diabetic, neither have I ever been told I have high blood sugar, I am just very overweight, at 72 years of age, 5ft 6 and 17 stone, my mobility due to rheumatoid arthritis is getting worse. I was accepted on the course, which lasted 10 months and was fortnightly to start with and then monthly. I found it informative, even though I thought I knew about diets and dieting. I found that what they advised, I was already doing, but it wasn't working.
I have recently started to follow a low carb diet, have paid for the Nutracheck app on my phone, and try to keep just under 1000 kcals a day. I don't eat bread, potatoes rice or pasta, just occasionally for a treat.

It is actually working, although I have lapsed over Christmas.
I bought the Michael Mosley fast 800 diet book and recipe book, although I don't stick too 800 calories, I use it for tips.
I decided that as the NHS seems to be little help, either with diet and exercise or medical treatment for my weight and arthritis problems, it was up to me to save myself.

@FixTheBone yet the NHS are paying for cholesterol etc drugs. They are trying to drive their costs down through treatment not refusing treatment.

What is a scandal is IF you do manage to find something healthy, its ridiculously priced compared to junk.

I'd often have the salad when eating out but I'm not paying 12-15 for a salad if I can have a steak dinner for equal or cheaper.

Yes I did overeat to become fat - I have been fat since I was 3 years old, put on my first diet (slim fast shakes) when I was 7 years old in 1998.

I was 'prescribed' a 1-1 service to help my weight loss. Unfortunately the dietician only worked 3 days a week 9-5. Not a lot of use if you work full time!

Had to give up after a couple of (lunchtime) sessions when parking became impossible.

I guess it depends on shift length but my family member who does 50 to 55 hours over 5 nights eats a cooked meal before shift and then takes a packed lunch.

I do this except can only afford a personal trainer once a week. It has been brilliant, but I've 'only' lost 2 stone over the year and that's stalled now so it's not the complete answer. I feel much better, healthier and stronger - but I'm still in the obese category and a size 18/20.

Look into a private prescription for WeGovy. It’s had a bad reputation because it’s been abused by Hollywood, but for people who genuinely have a weight problem and a challenging relationship with food it’s a game changer.

Sadly I’ve had similar with other areas of NHS, they aren’t a preventative medical institution but a reactive. Not sure that they could be specialist in all areas and as a society au e asking too much in some cases

It’s not entirely going to be helped by the governments seeming war on more active lifestyles in favour of the car.

Really this needs to be a whole government issue rather than just an nhs one.

The real scandal is that the NHS is paying its' staff and third party "consultants" to give such crap "advice"!

I've had an eating disorder for 40 years which led to T2 diabetes 25 years ago. I've seen a succession of NHS dieticians, so-called "specialist" diabetic GPs and nurses. Not a single one of them has had the faintest clue as to how to advise me! Until you experience the sheer stupidity of some of their "advice" you don't really how clueless they are. The "professional advice" of the last "specialist" GP I saw was that I join a few Facebook "binge eating" groups! Well Doh! I thought of that myself - you don't need a £100k GP to tell you the bloody obvious, you expect some "professional" advice!!

There's so much conflicting advice about what kind of "diet", i.e. low fat, low carb, low protein, high fat, high carb, high protein, you really don't know what to do. It all conflicts and you expect some proper guidance through it all from dieticians etc., but they're hopeless and usually make things even less clear as to what you need to do!

I feel your pain OP. I too have no gallbladder, years of disordered eating and yo yo dieting. The dietician I spoke to was actually very good in the importance of long term sustainable changes and focusing on both nutrition and a realistic mindset rather than cutting out entire food groups, but they cant suggest meal plans which is what I would find most helpful. I get weekly emails about diabetes even though I dont have it, and they than expect me to take a two hour round trip to stand on some scales even though I have told them that I dont wish to weigh myself as its a binge trigger. Thats all the support you get unless you want surgery.

The only good thing I have got is three months of free gym membership, however it excludes swimming which is the best activity for me.